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Drkoop
Goes Off the Record
January
25, 2000
Drkoop.com has quietly pulled back from Chairman C.
Everett Koop's promise to create an online "personal medical
record for all Americans."
The
Internet health company announced last February that it would
develop an electronic medical record. Drkoop said in July
it would provide the medical record to America Online (AOL)
's 20 million members as part of its $89 million deal to become
AOL (AOL) 's featured source of medical information. In turn,
AOL agreed to pay Drkoop.com $8 million to license the medical
record.
But
plans have changed since patients at a Florida hospital began
testing the prototype medical record in June, according to
Drkoop spokeswoman Stephanie Fulton. She says the reluctance
of some patients to put their health information online contributed
to a decision to reevaluate the project. Drkoop officials
had previously announced that the personal medical record
would be available in mid-1999.
"What
we've been hearing is that Americans are not ready for it,"
she says. "The issues of privacy, security and confidentiality
are still high in people's minds. We have not stopped development
of the personal medical record. We'll see how it goes."
Fulton
says the change of course will not affect the AOL agreement.
AOL spokeswoman Regina Lewis says the online medical records
deal with Drkoop "is on track."
"We
test things and test things and tweak them until they're ready
for prime time," she says. "We're just making sure we get
it right."
At
first blush, the decision by one of the most popular consumer
health Web sites to slow the development of an online medical
record would appear to be a setback to the widespread adoption
of such records. It would also seem to be a blow to Drkoop's
plans to eventually offer health care services like medical
monitoring.
But
the more likely consequence of Drkoop's retreat is a showdown
between the two types of online medical records offered today
those maintained by patients and those provided by physicians.
As with much of health care, it will come down to a matter
of trust: Will patients prefer to create and control their
medical records on consumer health sites or would they rather
access their "official" medical record through their doctor
or health plan's online service? Or will a combination of
the two prevail?
The
outcome will influence the direction of online health care.
Many in the industry see electronic medical records not only
as an effective tool to keep consumers loyal to health care
sites but also as the foundation for the delivery of health
care over the Internet. Earlier this month Drkoop chief executive
Donald Hackett told analysts at a Chase (CCF) Hambrecht &
Quist conference in San Francisco that "once you capture personal
medical records, you can start to push therapy."
The
online medical record essentially becomes a central repository
for information about an individual's health and a conduit
to connect people to their doctors, pharmacists and health
plans. A person's medical records currently may be scattered
in paper files maintained by several doctors and specialists.
Each physician may not necessarily know the patient's complete
medical history, medication use or how different treatments
and drugs may interact. For instance, it may not come out
during an eight-minute doctor's visit that a patient is taking
an herbal remedy that can have a dangerous interaction with
her blood-pressure medicine.
Now
put all that information into an online medical record. When
a patient with high blood pressure visits her doctor, the
physician sees a complete treatment history and a list of
her medications, past and present. The electronic medical
record runs any new prescriptions through a drug interaction
database, alerting the doctor to any dangerous side affects.
The doctor also checks a section of the record where the patient
keeps a personal health diary and learns that she recently
began taking ephedra. Dieters use ephedra as an appetite suppressant
but the herbal supplement can be hazardous to people with
high blood pressure.
The
doctor notes the patient's blood pressure in the medical record,
which is programmed to send e-mails reminding her to take
her medicine. The patient also signs up for a medical monitoring
service that allows her to take her own blood pressure readings
at home and download the readings into her record. If her
blood pressure gets too high, her doctor receives an alert
by e-mail or pager.
That's
the ideal anyway. Integration of all these features remains
under development. The few consumer health sites that currently
offer online medical records such as iVillage (IVIL) and
WebMD require that individuals record their health histories.
That means it's up to the patients to obtain medical information
from their doctors, pharmacies and laboratories, understand
those diagnoses and enter the data into their online medical
record. That's the case with the test version of Drkoop's
Personal Medical Record, which is being developed by Health
Magic of Winter Park, Fla.
"Consumers
may or may not be comfortable about entering their medical
records on the Web, just as they were uncomfortable about
entering their credit card information online," says Craig
Froude, chief executive of WellMed, a Portland, Ore., company
that supplies electronic medical records to iVillage's Allhealth.com,
and to corporations for use on company intranets. About 30,000
consumers currently use WellMed's online medical record, according
to Froude.
PersonalMD
of Pleasanton, Calif., also offers an online medical record
through its site and a partnership with Internet health insurance
company HealthAxis. CEO Suresh Challa describes the PersonalMD
online record as "a kind of an electronic shoebox for people
to store medical information." He says confidentiality and
security still concern consumers. But he points to the nearly
90,000 people who he says have signed up for the PersonalMD
record as evidence that "people overcome their fears as long
as they know benefits outweigh risks."
While
consumers may benefit from storing all their medical information
in one online location, it remains unknown whether physicians
and other health care providers will accept the legitimacy
of patient-created online medical records, particularly as
they pertain to medical histories and diagnoses.
"The
physician couldn't use it without talking to the consumer
because the validity of it is in question," says MedicaLogic
CEO David Leavitt, a doctor whose Hillsboro, Ore.-based company
has Internet-enabled its electronic medical record for physicians.
Patients whose doctors use the MedicaLogic service can access
their medical records online at the company's consumer site,
AboutMyHealth.net.
WellMed
tries to make its online medical record more palatable to
physicians by translating consumers' descriptions of their
health conditions into medical terminology. PersonalMD allows
consumers to fax paper medical records to the company, which
converts them into digital form.
The
online medical records industry remains in its infancy, but
the trend appears to be toward combining the physician and
consumer medical records. WebMD, for example, promises that
soon "health care professionals will be able to enter diagnostic
and prescription information directly into [the patient's]
health record."
Says
WellMed's Froude, "We think the ultimate medical record is
not the consumer medical record or the professional medical
record. You need to pair up personal information with the
clinical diagnosis that the doctor has provided."
Despite
Drkoop's decision to reevaluate its online medical record,
the number of online medical record companies likely will
grow. In November, Alameda, Calif.-based Healinx unveiled
its platform for allowing physicians and patients to share
medical files and communicate over the Internet. A San Francisco
company, MedicalRecord.com, began offering a consumer online
medical record last fall.
Fulton,
the Drkoop spokeswoman, says the company will concentrate
for now on acclimatizing its members to entering their health
information online by using health-risk calculators and health
condition trackers.
Says
a Drkoop executive who requested anonymity: "We've made a
strategic decision to take a slower and steadier approach.
Where we go will be determined where our users take us."
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Press
Contact for Media:
For
PersonalMD.com
Susan Cossette
Susan@PersonalMD.com
925/460-9088
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